Acceptability and feasibility of screening with a pediatric care provider-led social determinants of health identification tool

Background Complex social determinants of health may not be easily recognized by health care providers and pose a unique challenge in the vulnerable pediatric population where patients may not be able to advocate for themselves. The goal of this study was to examine the acceptability and feasibility of health care providers using an integrated brief pediatric screening tool in primary care and hospital settings. Methods The framework of the Child and Adolescent Needs and Strengths (CANS) and Pediatric Intermed tools was used to inform the selection of items for the 9-item Child and Adolescent Needs and Strengths-Pediatric Complexity Indicator (CANS-PCI). The tool consisted of three domains: biological, psychological, and social. Semi-structured interviews were conducted with health care providers in pediatric medical facilities in Ottawa, Canada. A low inference and iterative thematic synthesis approach was used to analyze the qualitative interview data specific to acceptability and feasibility. Results Thirteen health care providers participated in interviews. Six overarching themes were identified: acceptability, logistics, feasibility, pros/cons, risk, and privacy. Overall, participants agreed that a routine, trained provider-led pediatric tool for the screening of social determinants of health is important (n = 10, 76.9%), acceptable (n = 11; 84.6%), and feasible (n = 7, 53.8%). Interpretation Though the importance of social determinants of health are widely recognized, there are limited systematic methods of assessing, describing, and communicating amongst health care providers about the biomedical and psychosocial complexities of pediatric patients. Based on this study’s findings, implementation of a brief provider-led screening tool into pediatric care practices may contribute to this gap. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-024-04759-2.


INTRODUCTION
The CANS is a multiple purpose information integration tool that is designed to be the output of an assessment process.The purpose of the CANS is to accurately represent the shared vision of the child/youth serving system-children, youth, and families.As such, completion of the CANS is accomplished in order to allow for the effective communication of this shared vision for use at all levels of the system.Since its primary purpose is communication, the CANS is designed based on communication theory rather than the psychometric theories that have influenced most measurement development.There are six key principles of a communimetric measure that apply to understanding the CANS.
Six Key Principles of the CANS 1. Items were selected because they are each relevant to the explicit purpose of the version.An item exists because it might lead you down a different pathway in terms of planning actions.2. Each item uses a 4-level rating system.Those levels are designed to translate immediately into action levels.Different action levels exist for needs and strengths.3. Rating should describe the child/youth, not the child/youth in care.If an intervention is present that is masking a need but must stay in place, this should be factored into the rating consideration and would result in a rating of an "actionable" need (i.e."2" or "3").4. Culture and development should be considered prior to establishing the action levels.Cultural sensitivity involves considering whether cultural factors are influencing the expression of needs and strengths.Ratings should be completed considering the child/youth's developmental and/or chronological age depending on the item. 5.The ratings are generally "agnostic as to etiology".In other words this is a descriptive tool; it is about the "what" not the "why".6.A 30-day window is used for ratings in order to make sure assessments stay "fresh" and relevant to the child/youth's present circumstances.However, the action levels can be used to over-ride the 30-day rating period.
Action Levels for "Need" Items 0 -No Evidence of Need -This rating indicates that there is no reason to believe that a particular need exists.Based on current assessment information there is no reason to assume this is a need.

BIOLOGICAL DOMAIN
Check Medical/Diagnostic Complexity 0 The child's/youth's medical diagnoses are clear and there is no doubt as to the correct diagnoses; symptom presentation is clear. 1 Although there is some confidence in the accuracy of child's/youth's diagnoses, there also exists sufficient complexity in the child's/youth's symptom presentation to raise concerns that the diagnoses may not be accurate.2 There is substantial concern about the accuracy of the child's/youth's medical diagnoses due to the complexity of symptom presentation.3 It is currently not possible to accurately diagnose the child's/youth's medical condition(s).

Check Physical Symptom Severity
Please rate the highest level from the past 30 days Please rate the highest level from the past 30 days 0 Performing well in school with good achievement, attendance and behavior.No academic concerns.1 Performing adequately in school although some achievement, attendance or behaviour problems which have not dramatically affected the child's educational progress.Academic concerns are being addressed adequately. 2 Experiencing moderate problems with school achievement, attendance and/or behaviour that are currently interfering with the child's educational progress.Academic concerns are only partially addressed.3 Experiencing severe problems with school achievement, attendance and/or behaviour, preventing the child from educational progress consistent with their current developmental status.Academic concerns are not currently being addressed.Please rate the highest level from the past 30 days 0 No evidence of any current physical and /or mental health conditions including substance use-related or developmental problems among individuals responsible for providing parenting/care to the child. 1 Physical and /or mental health conditions including substance use-related or developmental problems present in one or more caregiver, which do not impact parenting.2 Physical and /or mental health conditions including substance use-related or developmental problems interfere with the caregiver(s) ability to take care of the child/youth.3 Physical and /or mental health conditions, including substance use-related or developmental problems present in one or more caregivers that prevent effective parenting and/or create a dangerous situation for the child/youth.Severe level of social factors that dramatically interfere with the child's health or wellbeing.Factors such as severe poverty, homelessness, or discrimination etc are having a significant effect on the child and/or family.Child youth is malnourished or in a dangerous environment; immediate change is necessary.All medical care is provided by a single health care professional.1 Child's/Youth's care is generally provided by a coordinated team of professionals who all work for the same organization.2 Child's/Youth's care requires collaboration of multiple professionals who work for more than one organization but current communication and coordination is effective.3 Child's/Youth's medical care requires the collaboration of multiple professionals who work for more than one organization and problems currently exist in communication among these professionals.
PSYCHOLOGICAL DOMAIN Check Developmental Needs/Cognitive Intellectual Development Check Emotional/Behavioral Needs Please rate the highest level from the past 30 days 0 No evidence of any current emotional problems (e.g.depression, anxiety, traumatic response) or behavioral (e.g. 3 No evidence of any coping skills.Inability to adapt to life stresses, changes, or to deal with unresolved feelings/emotions.Immediate risk.SOCIAL DOMAIN Check School Functioning and Educational Needs